Provider Demographics
NPI:1588851703
Name:THOMAS P. GRECO M D P C
Entity Type:Organization
Organization Name:THOMAS P. GRECO M D P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:GRECO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-709-3667
Mailing Address - Street 1:133 SCOVILL ST
Mailing Address - Street 2:SUITE 306
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06706-1127
Mailing Address - Country:US
Mailing Address - Phone:203-709-3667
Mailing Address - Fax:203-709-3663
Practice Address - Street 1:133 SCOVILL ST
Practice Address - Street 2:SUITE 306
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06706-1127
Practice Address - Country:US
Practice Address - Phone:203-709-3667
Practice Address - Fax:203-709-3663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-02
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT016133207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT010016133CT01OtherANTHEM BLUE CROSS OF CT
CT7139774551OtherCONNECTICARE
CT001161330Medicaid
CTC01862Medicare UPIN